TYPE: Original Investigations
PURPOSE: Since the advent of the lung allocation score (LAS), idiopathic pulmonary fibrosis (IPF) has become the most common indication for lung transplant. An acute exacerbation of IPF (AE-IPF) is defined as an acute, clinically significant respiratory deterioration characterized by evidence of new widespread alveolar abnormality, not explained by cardiac dysfunction. By virtue of clinical features, AE-IPF increases LAS to the point that transplant priority rises. The impact of AE-IPF on lung transplant outcomes remains unclear.
METHODS: All patients with IPF listed for lung transplant between July 2005 and October 2020 at Loyola University Medical Center were included. Retrospective chart review was performed to gather patient characteristics, including demographics, primary graft dysfunction (PGD), acute cellular rejection (ACR) within the first year, lung allocation score (LAS), and mortality. Continuous measures were compared using two-sample t-tests or Wilcoxon rank sum tests, and nominal characteristics were compared using chi-square or Fisher’s exact tests as appropriate. Age and sex-adjusted odds ratios for acute exacerbation status associated with outcomes were estimated from multivariable logistic regression models. A Kaplan Meier plot was used to display survival time by acute exacerbation status.
RESULTS: In total, 159 patients were included in this study, of which 17.6% (n=28) had an acute exacerbation at time of transplantation. Compared to patients with stable IPF at transplant, those with AE-IPF were more likely to have comorbidities (93% vs 74%, p=0.03), receive a bilateral transplant (61% vs 37%, p=0.02), and have higher oxygen and LAS (p<0.01 for all comparisons). Those with AE-IPF were also more likely to be intubated or on ECMO (p<0.001).Survival probabilities by AE status at transplant were similar throughout follow-up and did not differ at 90 days, 1-year or 3-year post-transplantation. Similarly, rates of grade 3 PGD or ACR within one year did not differ significantly and even trended lower for those with AE.
CONCLUSIONS: Patients with AE-IPF are more likely to have higher oxygenation requirements and higher LAS at time of lung transplantation than those with stable IPF. Despite this, there were no differences in survival at 90 days, one year, and three years, or differences in incidence of severe PGD or ACR.
CLINICAL IMPLICATIONS: Transplantation of patients with AE-IPF is associated with comparable clinical outcomes to transplantation of patients with stable IPF, including survival and incidence of PGD or acute rejection. This is in contrast with limited previous studies examining lung transplant in AE-IPF.
DISCLOSURES: Speaker/Speaker's Bureau relationship with Genentech Please note: 2018-2021 Added 04/20/2021 by Daniel Dilling, source=Web Response, value=Honoraria
Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: 2018-2021 Added 04/20/2021 by Daniel Dilling, source=Web Response, value=Honoraria
Research Support relationship with Boehringer Ingelheim Please note: 2018-2021 Added 04/20/2021 by Daniel Dilling, source=Web Response, value=Grant/Research Support
Research Support relationship with Nitto Denko Corporation Please note: 2020-2021 Added 04/19/2021 by Daniel Dilling, source=Web Response, value=Grant/Research
Research Support relationship with Lung Bioengineering, Inc. Please note: 2018-2021 Added 04/19/2021 by Daniel Dilling, source=Web Response, value=Grant/Research Support
Research Support relationship with Bellerophon Please note: 2018-2021 Added 04/29/2021 by Daniel Dilling, source=Web Response, value=Grant/Research Support
No relevant relationships by Christopher O'Hara, source=Web Response
No relevant relationships by Karen Sayad, source=Web Response
No relevant relationships by Krishnan Warrior, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.